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Second Bill to Reauthorize Children’s Health Insurance Program Approved by House

On October 25, the House approved, 265-142, a bill (H.R. 3963) to reauthorize the State Children’s Health Insurance Program (SCHIP) (P.L. 105-33), after defeating, 164-242, a motion to recommit by Rep. Joe Barton (R-TX). SCHIP’s current authorization expires on November 16, 2007; it was extended via a continuing resolution (P.L. 110-92) enacted on September 29 (see The Source, 9/28/07). Congress approved a previous version of the bill in late September (see The Source, 9/28/07), but it was vetoed by President Bush on October 3.

The draft measure would authorize $9.125 billion in FY2008, $10.675 billion in FY2009, $11.85 billion in FY2010, $13.75 billion in FY2011, and $3.5 billion in FY2012. A one-time appropriation of $12.5 billion would be available to the secretary of Health and Human Services for FY2012.

The bill would cap family income eligibility at 300 percent of the federal poverty line (FPL) ($61,950 for a family of four in 2007), with an exception for New Jersey; that state would be allowed to continue its policy of enrolling children with family incomes at or below 350 percent of the FPL. SCHIP coverage would include dental and mental health benefits for eligible children.

Illegal immigrants would be barred from enrolling in the SCHIP program. The measure would require applicants to provide a social security number and the Social Security Administration (SSA) to verify the number. If the SSA was unable to verify an applicant’s citizenship status, additional “documentary evidence” would be required.

States that already have a waiver in place to cover childless adults would be permitted to continue coverage through FY2008; thereafter, coverage for such adults would be terminated. Similarly, new waivers to cover childless adults would be prohibited. Pregnant women could be covered under SCHIP under the following conditions: if a state uses Medicaid funds to cover those with incomes up to 185 percent of the FPL; if the state covers children up to 200 percent of the FPL; if the state does not have a waiting list, enrollment cap, or other limitation on children’s coverage; and if it does not cover pregnant women at higher eligibility levels than it insures children. The bill would presume that any child born to an eligible woman is eligible for SCHIP or Medicaid and would provide health care coverage until the child’s first birthday; thereafter, the woman would have to apply for Medicaid or SCHIP for the child.

The bill would establish a new grant program for state, local, and tribal governments; community or public health organizations; faith-based organizations; and elementary and secondary schools to finance outreach and enrollment efforts to target underserved populations, including Native American children, children who reside in rural areas, racial and ethnic minorities, and those with cultural and linguistic barriers to enrollment. The grant program would be authorized at $100 million per year for FY2008-2012.

The increase in SCHIP spending would be offset by increasing the federal tax on cigarettes by 61 cents to one dollar per pack. The increase would take effect December 31, 2007.

During debate on the measure, Rep. Carolyn Kilpatrick (D-MI) said, “Passing this legislation should be a bipartisan issue. SCHIP was created to address the growing problem of children in the United States without health insurance…A lack of medical insurance not only harms children, but their families and the community as a whole. Reauthorizing this bill is so important because children without health insurance do not receive regular checkups and doctor visits that every child needs. May I remind my colleagues that less than 10 miles from where we vote, a little boy died from the lack of getting a simple dental examination. Furthermore, millions of children won’t get the preventive care they need and will likely receive care in emergency rooms if this bill is not reauthorized. This only drives up the cost of medical care for everyone. SCHIP gives working families the peace of mind that their children will have accessible and affordable health care. Healthy children do not get unnecessary diseases and go to school ready to learn. Healthy children become healthy teenagers, who ultimately will become healthy adults. Although children are about 30 percent of our population, they are 100 percent of our future. This $35 billion is a wise investment in the future of America.”

Rep. Nathan Deal (R-GA) said, “[T]oday we are dealing with a bill that supposedly is a fix of the previous legislation that has been vetoed…First of all, there is supposed to have been a fix on the issue of illegal immigration. CBO [Congressional Budget Office] still estimates that there will be $3.7 billion of increased federal spending and complementary state spending that will total some $6.5 billion of additional spending because of this change as it relates to the immigration issue over the next 10 years, and an additional 100,000 adults will gain eligibility because of this section…The authors of this bill also claim there is a fix on the issue of adults in SCHIP. The fact [is] that CBO still projects that up to 10 percent of the enrollees in SCHIP will be adults, not children, in the next five years, and money for poor children shouldn’t, in my opinion, go to cover adults…The CBO still estimates there will be some two million people who will lose their private health insurance coverage and become enrolled in a government-run program…CBO estimates there will only be some 800,000 who are currently eligible for SCHIP who will be enrolled in the next five years, but an additional 1.1 million people with incomes that are not currently eligible for SCHIP will be enrolled in the program. I urge a ‘no’ vote.”

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